Anthropometry

Height

1

Description
Adult height is determined not only by genetic endowment but also by health, nutrition/diet and psychological stress through the developmental years. Social and developmental factors related to adult height include parental height, birth weight, childhood social class, birth order, number of younger siblings, year of birth, parental education, household crowding, childhood diet, and serious illness in childhood.

Stunting is of particular concern in examining the relationship of height to health outcomes. Stunting refers to extremely short stature, defined by comparison to the age- and sex-specific length or height reference population developed by CDC’s National Center for Health Statistics (NCHS) (Centers for Disease Control and Prevention, 1998) and adopted by the World Health Organization for international use. Stunting, a condition developing in early childhood, directly results from poor diets and regular and/or severe infection, generally occurring before 18 months. Thus, stunting serves as an indicator of early childhood experience including inadequate nutrition, chronic or recurrent infections, low birth weight and sometimes extreme psychosocial stress without nutritional deficiencies (Lewit and Kerrebrock, 1997). Stunting is also associated with other biological risk dimensions in later life.

Significance of Measurement
Height has been related to the risk of chronic conditions, diseases and death among older persons. There is an inverse association between height and overall mortality (Davey Smith et al., 2000; Song et al., 2003), with stroke (McCarron et al., 2001; Song et al., 2003), and with cardiovascular disease (Davey Smith et al., 2000; Gunnell et al., 2003). On the other hand the association between height and cancer is positive (Davey Smith et al., 2000; Gunnell et al., 2001). Because height rarely changes during adulthood, the association of greater stature with an increased risk of cancer and a decreased risk of cardiovascular disease appears to reflect the long-term consequences of pre-adult conditions.

Method of Measurement
Standing height is measured by standing with the feet together, without shoes. One looks straight ahead. The tape is extended, placing it on top of the head, without pressing. (Interviewer manual for MHAS)

References
· Centers for Disease Control and Prevention. (1998). Pediatric nutrition surveillance, 1997 full report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
· Davey Smith, G., Hart, C., Upton, M., Hole, D., Gillis, C., Watt, G., et al (2000). Height and risk of death among men and women: Aetiological implications of associations with cardiorespiratory disease and cancer mortality. Journal of Epidemiology and Community Health, 54, 97-103.
· Gunnell, D., Okasha, M., Davey Smith, G., Oliver, S., Sandhu, J., & Holly, J. (2001). Height, leg length and cancer risk: A systematic review. Epidemiological Review, 23, 313-342.
· Gunnell, D., Whitley, E., Upton, M.N., McConnachie, A., Davey Smith, G., & Watt, G.C.M. (2003). Associations of height, leg length and lung function with cardiovascular risk factors in the Midspan Family Study. Journal of Epidemiology and Community Health, 57, 141-146.
· Lewit, E., & Kerrebrock, N. (1997). Population-based growth stunting. The Future of children: Children and poverty, 7(2), 149-156.
· McCarron, P., Hart, C.L., Hole, D., & Davey Smith, G. (2001). The relation between adult height and haemorrhagic and ischaemic stroke in the Renfrew/Paisley study. Journal of Epidemiology and Community Health, 55, 404-405.
· Song, Y.M., Davey Smith, G., & Sung, J. (2003). Adult height and cause-specific mortality: A large prospective study of Korean men. American Journal of Epidemiology, 158, 479-485.

Leg Length

1

Description
Height is often separated into two components - leg length and trunk length. Leg length, also called leg height and lower limb development, is thought to be more affected than trunk length by adverse childhood circumstances (Leitch, 1951). Adult leg length is particularly sensitive to diet (breastfeeding and energy intake) in early childhood given the rapidity of leg growth in this period (Wadsworth et al., 2002).

Significance of Measurement
Recent studies have shown that the association of overall height with cancer and cardiovascular disease is attributed to leg length (Davey Smith et al., 2001; Gunnell et al., 1998, 2001). Studies have shown that there is the positive association between leg height and cancer (Gunnell et al., 2001; Lawlor et al., 2003) and the inverse association between leg height and cardiovascular risk (Davey Smith et al., 2001; Gunnell et al., 2003).

References
· Davey Smith, G., Greenwood, R., Gunnell, D., Sweetnam, P., Yarnell, J., & Elwood, P. (2001). Leg length, insulin resistance, and coronary heart disease risk: The Caerphilly Study. Journal of Epidemiology and Community Health, 55, 867-872.
· Gunnell, D.J., Davey Smith, G., Holly, J.M.P., & Frankel, S. (1998). Leg length and risk of cancer in the Boyd Orr cohort. British Medical Journal, 317, 1350-1351.
· Gunnell, D., Okasha, M., Davey Smith, G., Oliver, S., Sandhu, J., & Holly, J. (2001). Height, leg length and cancer risk: A systematic review. Epidemiological Review, 23, 313-342.
· Gunnell, D., Whitley, E., Upton, M.N., McConnachie, A., Davey Smith, G., & Watt, G.C.M. (2003). Associations of height, leg length and lung function with cardiovascular risk factors in the Midspan Family Study. Journal of Epidemiology and Community Health, 57, 141-146.
· Lawlor, D.A., Okasha, M., Gunnell, D., Davey Smith, G., & Ebrahim S. (2003). Associations of adult measures of childhood growth with breast cancer: findings from the British Women’s Heart and Health Study. British Journal of Cancer, 89, 81-87.
· Leitch, I. (1951). Growth and health. British Journal of Nutrition, 5, 142-151.
· Wadsworth, M., Hardy, R., Paul, A., Marshall, S., & Cole, T. (2002). Leg and trunk length at 43 years in relation to childhood health, diet and family circumstances: Evidence from the 1946 national birth cohort. International Journal of Epidemiology, 31, 383-390.

Weight, Body Mass Index (BMI), Waist / Hip Size

1

Description
Anthropometric measures such as weight, Body Mass Index (BMI), waist and hip circumference and waist-to-hip ratio (WHR) are related to circumstances closer to the time of measurement. These adiposity measures indicate the balance between energy intake and energy expenditure.

These measures have recently gained greater attention because of the increasing prevalence of the overweight and obesity in all age groups (Gutierrez-Fisac et al., 2000; Heitmann, 2000; Lahti-Koski et al., 2000; Tremblay et al, 2002).

The World Health Organization (WHO) defines overweight as BMI between 25 and 29.9 and obesity as BMI equal to or greater than 30. Obesity is further divided by three categories -30 to 34.9 (obese 1), 35 to 39.9 (obese 2), and 40 and above (obese 3) (WHO Expert Consultation, 2004)

Significance of Measurement
Those with higher values of BMI, wait and hip circumferences, and WHR tend to be at higher risks for hypertension, adult-onset diabetes mellitus, heart disease, stroke, various forms of cancer, atherosclerosis (Folsom et al., 1994; Lapidus et al., 1984; Larsson et al., 1984; McKeigue et al., 1991; National Heart, Lung, and Blood Institute, 1998; Ohlson et al., 1985; Welin et al., 1987; Zhang et al., 2004), osteoarthritis (Felson et al., 1992), increased inactivity, resulting in lower aerobic capacity and less muscle strength (Andersen et al., 2001), and disability (Blaum et al., 2003; Davison et al., 2002; Dey et al., 2002; Himes, 2000; Must et al., 1999). High WHR was also found to be related to some somatic and psychological health problems (Adler et al., 1999; Seeman et al., 1997).

Some clinical studies have found the importance of fat distribution in affecting adiposity-related diseases and mortality. They argue that it is not obesity per se but the distribution of the adipose tissue that is related to increased risk for those diseases and conditions (Donahue et al., 1987; Ducimetiere et al., 1985). Among people with equal degree of adiposity, those with a central distribution of fat (android or apple body shape) tend to experience higher rates of atherosclerotic heart disease, stroke, hypertension, hyperlipidemia and diabetes than those with a peripheral distribution of fat (gynoid or pear body shape).

Thus, some researchers prefer WHR and waist circumference (WC) to BMI as a better predictor for cardiovascular risk (Dagenais et al., 2005) and other adiposity-related conditions. While BMI provides an index of obesity, WHR may be more useful as an index of more chronic levels of metabolism and adipose tissue deposition (Seeman et al., 1997). According to the guideline provided by the National Cholesterol Education Program (NCEP) ATP III (Adult Treatment Panel III) on metabolic syndrome (which represents a constellation of lipid and nonlipid risk factors of metabolic origin) (Expert Panel, 2001), the use of simple measure of waist circumference instead of BMI is recommended to identify the body weight component of metabolic syndrome (men>40 inc; women>35 inc).

Method of Measurement
BMI is calculated in kilograms of weight, and height in meters, as the ratio of weight to height-squared (kg/m2).

Waist circumference is measured at its narrowest point between the ribs and iliac crest and hip circumference is measured at the maximal buttocks.

References
· Adler, N.E., Marmot, M., McEwen, B., & Stewart, J. (Eds.). (1999). Socioeconomic status and health in industrial nations: Social, psychological, and biological pathways. Annals of the New York Academy of Sciences, 896, 1–500.
· Andersen, R.E., Franckowiak, S., Christmas, C., Walston, J. & Crespo, C. (2001). Obesity and reports of no leisure time activity among old Americans: Results from the third national health and nutrition examination survey. Educational Gerontology, 27, 297-306.
· Blaum, C.S., Ofstedal, M.B., Langa, K.M., & Wray, L.A. (2003). Functional status and health outcomes in older Americans with diabetes mellitus. Journal of the American Geriatrics Society, 51, 745-753.
· Dagenais, G.R., Yi, Q., Mann, J.F.E., Bosch, J., Pogue, J., & Yusuf, S. (2005). Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease. American Heart Journal, 149, 54-60.
· Davison, K.K., Ford, E.S., Cogswell, M.E., & Dietz, W.H. (2002). Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III. Journal of the American Geriatrics Society, 50, 1802-1809.
· Dey, D.K., Rothenberg, E., Sundh, V., Bosaeus, I., & Steen, B. (2002). Waist circumference, body mass index, and risk for stroke in older people: A 15-year old longitudinal population study of 70-year olds. Journal of the American Geriatrics Society, 50, 1510-1518.
· Donahue, R.P., Abbott, R.D., Bloom, E., Reed, D.M., & Yano, K. (1987). Central obesity and coronary heart disease in men. Lancet, 1, 821-824
· Ducimetiere, P., Richard, J., Cambien, F., Avous, P., & Jacqueson, A. (1985). Relationship between adiposity measurements and the incidence of coronary heart disease in a middle-aged male population. The Paris Prospective Study I. American Journal of Nutrition, 4, 31-38.
· Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. (2001). Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Journal of the America Medical Association, 285(19), 2486-2497.
· Felson, D.T., Zhang, Y., Anthony, J.M., Naimark, A. & Anderson, J.J. (1992). Weight loss reduces the risk for symptomatic knee osteoarthritis in women. Annals of Internal Medicine, 116, 535-539.
· Folsom, A.R., Kaye, S.A., Sellers, T.A., Hong, C., Cerhan, J.R., Potter, J.D., et al (1993). Body fat distribution and 5-year risk of death in older women. Journal of the American Medical Association, 269, 483-487.
· Gutierrez-Fisac, J.L., Banegas Banegas, J.R., Rodriguez Artalejo, F.R. & Regidor, E. (2000). Increasing prevalence of overweight and obesity among Spanish adults, 1987-1997. International Journal of Obesity, 24, 1677-1682.
· Heitmann, B.L. (2000). Ten-year trends in overweight and obesity among Danish men and women aged 30-60 years. International Journal of Obesity, 24, 1347-1352.
· Himes, C.L. (2000). Obesity, disease, and functional limitation in later life. Demography, 37(1), 73-82.
· Lahti-Koski, M., Vartiainen, E., Mannisto, S., & Pietinen, P. (2000). Age, education and occupation as determinants of trends in body mass index in Finland from 1982-1997. International Journal of Obesity, 24, 1669-1676.
· Lapidus, L., Bengtsson, C., Larsson, B., Pennert, K., Rybo, E., & Sjostrom, L. (1984). Distribution of adipose tissue and risk of cardiovascular disease and death: A 12 year follow up of participants in the population study of women in Gothenburg, Sweden. British Medical Journal, 289, 1257-1261.
· Larsson, B., Svardsudd, K., Welin, L., Wilhelmsen, L., Bjorntorp, P., & Tibblin, G. (1984). Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. British Medical Journal, 288, 1401-1404.
· McKeigue, P.M., Shah, B., & Marmot, M.G. (1991). Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular in South Asians. Lancet, 337, 382-386.
· Must, A., Spadano, J., Coakley, E.H., Field, A.E., Colditz, G., & Dietz, W.H. (1999). The disease burden associated with overweight and obesity. Journal of the American Medical Association, 282, 1523-1529.
· National Heart, Lung, and Blood Institute. (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Washington, D.C.: US Public Health Service.
· Ohlson, L.O., Larsson, B., Svardsudd K., Welin, L., Eriksson, H., Wilhelmsen, L., et al (1985). The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes, 34, 1055-1058.
· Seeman, T.E., Singer, B.H., Rowe, J.W., Horwitz, R.I., & McEwen, B.S. (1997). Price of adaptation--allostatic load and its health consequences. MacArthur studies of successful aging [published erratum appears in (1999), Archives of Internal Medicine, 159(11), 1176]. Archives of Internal Medicine, 157(19), 2259-2268.
· Tremblay, M.S., Katzmarzyk, P.T., & Willms, J.D. (2002). Temporal trends in overweight and obesity in Canada, 1981-1996. International Journal of Obesity, 26, 538-543.
· Welin, L., Svardsudd, K., Wilhelmsen, L., Larsson, B., & Tibblin, G. (1987). Analysis of risk factors for stroke in a cohort of men born in 1913. New England Journal of Medicine, 317, 521-526.
· WHO Expert Consultation. (2004). Appropriate body-mass index for Asian populations and its application for policy and intervention strategies. Lancet, 363(9403), 157-163.
· Zhang, X., Shu, X.O., Gao, Y.T., Yang, G., Matthews, C.E., Li, Q., et al (2004). Anthropometric predictors of coronary heart disease in Chinese women. International Journal of Obesity, 28, 734-740.
· Please refer to the Research Network on Socioeconomic Status and Health website for details. http://www.macses.ucsf.edu/Research/Allostatic/notebook/body.html
http://www.macses.ucsf.edu/Research/Allostatic/notebook/fat.html